Eyeworld

34 | EYEWORLD | WINTER 2024 ATARACT C Relevant disclosures Braga-Mele: Alcon Donaldson: AbbVie, Alcon, Bausch + Lomb, BioTissue, BVI, Carl Zeiss Meditec, Dompe, Eyevance, Glaukos, iOR, Johnson & Johnson Vision, Kala, LENSAR, Lumenis, Novartis, Omeros, Oyster Point, Quidel, PRN, Rayner, Science Based Health, Sun, Tarsus, Versea Rubenstein: Alcon selection at this time was short, and most patients chose a monofocal lens. Soon two new multifocal lenses joined the pack, but Dr. Donaldson said these and the other lenses that tried to offer more spectacle independence had significant dysphotopsias (associated with high near add powers). "For the most part, we were not very savvy explaining dysphotopsia profiles, and surgeons quickly became frustrated with unpredictable visual side effects," she said. "We had many happy patients, but just a single unhappy patient could be devastating to clinic flow and to surgeon confidence. This limited the pen- etration of premium lens technology into the market. "Today, we are very fortunate to have a plethora of lens options with much improved dysphotopsia profiles," she continued. "How- ever, lens discussions can consume a great deal of chair time. In larger, high-volume premium practices, specialized staff may whisk the pa- tient away for a full review of the lens options, but it is still the doctor's responsibility to help the patient decide what best suits their ocular health and their lifestyle. In most practices, this is one of the most time-consuming responsibili- ties of the typical cataract surgeon." Looking forward, Dr. Donaldson said she thinks AI and realistic vision simulators will play a role in lens selection. "AI could combine patient lifestyle informa- tion, desires for spectacle freedom, and financial concerns with clinical data (including macular health, astigmatism, and degree of myopia or hyperopia) to produce a lens recommendation. The more information input into the system, the more robust the algorithm would become," she said, adding later that "improved patient educa- tional tools, including realistic simulators, could help provide an opportunity to trial various lens options before surgery. This would increase sur- geon and patient confidence with lens choices. It would also help patients better understand potential dysphotopsias." 'There is an art to this' Jonathan Rubenstein, MD When it comes to making an IOL recommen- dation to the patient, informing the patient to select their best option is, Dr. Rubenstein said, "a combination of art and science." "Once I determine their candidacy with the exam and review of imaging, I discuss the patient's goals for their surgery. I assess their visual needs by learning about their occupation and pastimes and assess their potential desire for spectacle freedom," she said. While she and the patient might discuss different lens options, Dr. Donaldson said she al- ways ends the consultation with a concrete lens recommendation, clearly stated in the patient's chart. "This is very important for my staff that will take the conversation to the next level. It delivers one message to the patient, despite who they may be interacting with in the office. My surgical coordinator will then discuss scheduling and finances in more detail following our office visit. If the patient calls with additional ques- tions after our visit, staff can refer back to my note and specific recommendation to make sure we are consistent with our message and not causing patient confusion," Dr. Donaldson said. When Dr. Donaldson started practicing 20 years ago, she said there were basic monofocal lenses, one multifocal lens, and one accom- modating lens. The discussion involving lens continued from page 33 Source: iStock.com/SDI Productions

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